目的 运用系统评价的方法评价全面无反应性量表(FOUR)评分和格拉斯哥昏迷量表(GCS)评分对脑创伤患者早期预后的预测作用.方法 计算机检索中国知网、维普网、万方数据知识服务平台、PubMed、the Cochrane Library、EMbase数据库中FOUR评分及GCS评分对脑创伤患者早期预后预测作用相关的文献,并手工检索相关文献,检索时限为2005—2015年.所检索文献由两名研究者参照预先设定的标准独立评判,并对纳入文献进行筛选,同时进行质量评价,提取所需数据.采用RevMan 5.3软件进行Meta分析.结果 最终纳入8个队列研究,共689例患者.Meta分析结果显示,689例脑创伤患者中,FOUR评分预测患者院内死亡97例,GCS评分预测患者院内死亡72例,FOUR评分预测脑创伤患者院内病死率高于GCS评分,差异有统计学意义〔RR=1.35,95%CI(1.02,1.78), P=0.04〕.结论 依照当前证据,与GCS评分比较,FOUR评分对脑创伤患者早期预后有较好的预测作用.FOUR评分可以代替GCS评分对脑创伤患者意识进行评估并对其近期预后进行预测.但对脑创伤患者的远期预后,受限于文献统计数据,尚需要进一步进行研究.%Objective To systematically evaluate the predictive value of Full Outline of Unresponsiveness Scale (FOUR) and Glasgow Coma Scale (GCS) for early prognosis of patients with traumatic brain injury.Methods We searched the databases of CNKI,VIP,Wanfang Data,PubMed,the Cochrane Library and EMbase and printed literature from 2005 to 2015 for studies that assessed the predictive value of FOUR and GCS for early prognosis of patients with traumatic brain injury. Studies screening based on the preset inclusion and exclusion criteria,quality assessment and data extraction were conducted by two researchers separately.Meta-analysis of data was performed by the RevMan 5.3 software.Results Finally,eight cohort studies involving 689 patients were included.The results of meta analysis showed that,among the 689 patients with traumatic brain injury,97 deaths were predicted by FOUR score,and 72 deaths were predicted by GCS score,the in-hospital mortality in these patients predicted by FOUR score was higher than that by GCS score 〔RR=1.35,95%CI (1.02,1.78),P=0.04〕. Conclusion According to current evidence,FOUR has a better predictive value for early prognosis of traumatic brain injury compared with GCS.Therefore,FOUR score can replace the GCS score to assess the consciousness and predict the short-term prognosis of patients with traumatic brain injury.However,due to limited studies,the predictive value of FOUR for the long-term prognosis of these patients still needs further study.
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